Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2019; 25(32): 4739-4748
Published online Aug 28, 2019. doi: 10.3748/wjg.v25.i32.4739
Prognostic value of red blood cell distribution width for severe acute pancreatitis
Fang-Xiao Zhang, Zhi-Liang Li, Zhi-Dan Zhang, Xiao-Chun Ma
Fang-Xiao Zhang, Zhi-Liang Li, Zhi-Dan Zhang, Xiao-Chun Ma, Department of Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Author contributions: Zhang FX, Ma XC, and Zhang ZD designed the research; Zhang FX and Li ZL performed the research; Li ZL contributed new reagents/analytic tools; Zhang FX, Li ZL, and Zhang ZD analyzed the data; Zhang FX and Zhang ZD wrote the paper.
Supported by Health and Birth Control Committee of Liaoning Province, China.
Institutional review board statement: The study was reviewed and approved by the Medical Science Ethics Committee of First Affiliated Hospital of China Medical University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhi-Dan Zhang, Doctor, Department of Critical Care Medicine, First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang 110001, Liaoning Province, China. 13998318999@163.com
Telephone: +86-139-9831-8999
Received: April 28, 2019
Peer-review started: April 28, 2019
First decision: May 30, 2019
Revised: July 2, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: August 28, 2019
Abstract
BACKGROUND

Severe acute pancreatitis (SAP) is a common condition in the intensive care unit (ICU) and has a high mortality. Early evaluation of the severity and prognosis is very important for SAP therapy. Recently, red blood cell distribution (RDW) was associated with mortality of sepsis patients and could be used as a predictor of prognosis. Similarly, RDW may be associated with the prognosis of SAP patients and be used as a prognostic indicator for SAP patients.

AIM

To investigate the prognostic value of RDW for SAP patients.

METHODS

We retrospectively enrolled SAP patients admitted to the ICU of the First Affiliated Hospital of China Medical University from June 2015 to June 2017. According to the prognosis at 90 d, SAP patients were divided into a survival group and a non-survival group. RDW was extracted from a routine blood test. Demographic parameters and RDW were recorded and compared between the two groups. The receiver operator characteristic (ROC) curve was constructed and Cox regression analysis was performed to investigate the prognostic value of RDW for SAP patients.

RESULTS

In this retrospective cohort study, 42 SAP patients were enrolled, of whom 22 survived (survival group) and 20 died (non-survival group). The baseline parameters were comparable between the two groups. The coefficient of variation of RDW (RDW-CV), standard deviation of RDW (RDW-SD), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score were significantly higher in the non-survival group than in the survival group (P < 0.05). The RDW-CV and RDW-SD were significantly correlated with the APACHE II score and SOFA score, respectively. The areas under the ROC curves (AUCs) of RDW-CV and RDW-SD were all greater than those of the APACHE II score and SOFA score, among which, the AUC of RDW-SD was the greatest. The results demonstrated that RDW had better prognostic value for predicting the mortality of SAP patients. When the RDW-SD was greater than 45.5, the sensitivity for predicting prognosis was 77.8% and the specificity was 70.8%. Both RDW-CV and RDW-SD could be used as independent risk factors to predict the mortality of SAP patients in multivariate logistic regression analysis and univariate Cox proportional hazards regression analysis, similar to the APACHE II and SOFA scores.

CONCLUSION

The RDW is greater in the non-surviving SAP patients than in the surviving patients. RDW is significantly correlated with the APACHE II and SOFA scores. RDW has better prognostic value for SAP patients than the APACHE II and SOFA scores and could easily be used by clinicians for the treatment of SAP patients.

Keywords: Red blood cell distribution width, Severe acute pancreatitis, Prognosis, Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score

Core tip: Our study aimed to investigate the prognostic value of red blood cell distribution (RDW) for severe acute pancreatitis (SAP) patients. We retrospectively enrolled 42 SAP patients admitted to the intensive care unit in two years. The results suggested that RDW is greater in the non-surviving SAP patients than in the surviving patients. RDW is significantly correlated with the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores. RDW has better prognostic value for SAP patients than the APACHE II and SOFA scores and could easily be used by clinicians for the treatment of SAP patients.